Advertisement

Ulnar shortening osteotomy for posttraumatic ulnar impaction syndrome in adolescent (younger than 18 years) - Based on the Cha & Shin assessment -

  • Soo Min Cha
    Affiliations
    Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
    Search for articles by this author
  • Hyun Dae Shin
    Correspondence
    Corresponding author at: Department of Orthopedic Surgery, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, Korea.
    Affiliations
    Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
    Search for articles by this author
  • Yun Ki Kim
    Affiliations
    Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
    Search for articles by this author
  • Kun Woo Lee
    Affiliations
    Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
    Search for articles by this author
Published:October 06, 2022DOI:https://doi.org/10.1016/j.injury.2022.10.004

      Highlights

      • Our authors also encountered consecutive cases of secondary ulnar impaction syndrome (UIS) associated with traumatic events in the past two decades. The amount of shortening was classified into three categories.
      • The first category was for a still open physis on the medial half of the radius in those younger than 15. In this category, we osteotomized the ulna for the physis level to be left neutral or negative by 1–2 mm.
      • The second category had no growth potency in the radius. If the patient was younger than 15, we considered only residual growth of the ulna, thus performing ulnar shortening osteotomy (USO) for the ordinary ulnar variance (UV) to be negative by 2–3 mm.
      • The third category was no growth potential in both the radius and ulna. For this category, traditional USO was performed with a neutral UV.
      • UIS after trauma to the physis in children and younger adolescents could be properly treated by USO. Even with an open physis at the ulna, neutral UVs could be achieved, and the clinical outcomes were satisfactory. However, long-term follow-up is still needed regarding TFCC and DRUJ status.

      Abstract

      Purpose

      We performed ordinary ulnar shortening osteotomy (USO) in patients younger than 18 years old with secondary ulnar impaction syndrome (UIS) after traumatic events. Here, we report the clinical and radiologic outcomes with a review of the previous literature through a retrospective case series.

      Methods

      Twenty-two adolescents treated by USOs from 2006 to 2018 were investigated. The amount of shortening was classified into three categories. The first category was for a still open physis on the medial half of the radius in those younger than 15. In this category, we osteotomized the ulna for the physis level to be left neutral or negative by 1–2 mm. The second category had no growth potency in the radius. If the patient was younger than 15, we considered only residual growth of the ulna, thus performing USO for the ordinary UV to be negative by 2–3 mm. For patients aged 15–18 years old, if growth potency was nearly absent in the ulna, we performed traditional USO with a neutral ulnar variance (UV).

      Results

      Categories 1, 2, and 3 for the amount of USO were determined for 4, 4, and 14 patients, respectively. All USOs properly healed without substantial complications. The mean preoperative UV was 2.91 mm, and the final value decreased to 0.23 with statistical significance (p < 0.001). The range of wrist motion was improved after USO from 133.86° and 132.73° to 154.77° and 160.68° (all, p < 0.001 in flexion-extension and pronation-supination arcs, respectively). The preoperative VAS and MMWS scores also improved from 2.77 to 75.00 to 0.18 and 88.86, respectively, at the final follow-up (all, p < 0.001).

      Conclusions

      UIS in adolescent populations after trauma in their children/younger adolescents could be properly treated by USO. Even with an open physis at the ulna, neutral UVs could be achieved, and the clinical outcomes were satisfactory. However, long-term follow-up is still needed regarding TFCC and DRUJ status.

      Level of evidence

      Level IV, retrospective case series

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Farr S.
        • Ganger R.
        • Girsch W.
        A unique case of temporary epiphysiodesis in an adolescent patient with ulnocarpal impaction syndrome.
        J Hand Surg Eur Vol. 2013; 38: 1003-1004
        • Zimmermann R.
        • Gschwentner M.
        • Kralinger F.
        • Arora R.
        • Gabl M.
        • Pechlaner S.
        Long-term results following pediatric distal forearm fractures.
        Arch Orthop Trauma Surg. 2004; 124: 179-186
        • Cha S.M.
        • Shin H.D.
        • Kim K.C.
        • Park E.
        Ulnar shortening for adolescent ulnar impaction syndrome: radiological and clinical outcomes.
        J Hand Surg Am. 2012; 37: 2462-2467
        • Baek G.H.
        • Chung M.S.
        • Lee Y.H.
        • Gong H.S.
        • Lee S.
        • Kim H.H.
        Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome.
        J Bone Joint Surg Am. 2005; 87: 2649-2654
        • Mann D.C.
        • Rajmaira S.
        Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years.
        J Pediatr Orthop. 1990; 10: 713-716
        • Peterson C.A.
        • Peterson H.A.
        Analysis of the incidence of injuries to the epiphyseal growth plate.
        J Trauma. 1972; 12: 275-281
        • Kihara H.
        • Palmer A.K.
        • Werner F.W.
        • Short W.H.
        • Fortino M.D.
        The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation.
        J Hand Surg Am. 1996; 21: 40-47
        • Abzug J.M.
        • Little K.
        • Kozin S.H.
        Physeal arrest of the distal radius.
        J Am Acad Orthop Surg. 2014; 22: 381-389
        • van der Post A.S.
        • Jens S.
        • Jacobs K.
        • Smithuis F.F.
        • Obdeijn M.C.
        • Maas M
        Ulnar variance and triangular fibrocartilage thickness in adolescents: a cross-sectional MRI study of healthy participants.
        J Hand Surg Eur Vol. 2022; 47: 722-727
        • Lee S.J.
        • Bae D.S.
        Triangular fibrocartilage complex injuries in children and adolescents.
        Hand Clin. 2021; 37: 517-526
        • Schachinger F.
        • Farr S.
        Arthroscopic treatment results of triangular fibrocartilage complex tears in adolescents: a systematic review.
        J Clin Med. 2021; 10: 2363
        • Valverde J.A.
        • Albiñana J.
        • Certucha J.A.
        Early posttraumatic physeal arrest in distal radius after a compression injury.
        J Pediatr Orthop B. 1996; 5 (Winter): 57-60
        • Ellanti P.
        • Harrington P.
        Acute ulnar shortening for delayed presentation of distal radius growth arrest in an adolescent.
        Case Rep Orthop. 2012; 2012928231
        • Moon D.K.
        • Park J.S.
        • Park Y.J.
        • Jeong S.T.
        Simultaneous correction of radius and ulna for secondary ulnar impaction syndrome with radial physeal arrest in adolescent: a case report and review of literatures.
        Int J Surg Case Rep. 2018; 50: 144-149
        • Sarkar A.S.
        • Bandyopadhyay R.
        • Niyogi P.G.
        Single-stage distal radius dome osteotomy with ulnar diaphyseal shortening and distal ulnar epiphysiodesis in a case of Manus valgus deformity secondary to post-traumatic physeal growth arrest - a case report.
        J Orthop Case Rep. 2021; 11: 4-7
        • Campbell T.
        • Faulk L.W.
        • Vossler K.
        • Goodrich E.
        • Lalka A.
        • Sibbel S.E.
        • Sinclair M.K.
        Ulnar epiphysiodesis: success of the index procedure.
        J Pediatr Orthop. 2022; 42: 158-161
        • Scheider P.
        • Ganger R.
        • Farr S.
        Temporary epiphysiodesis in adolescent patients with ulnocarpal impaction syndrome: a preliminary case series of seven wrists.
        J Pediatr Orthop B. 2021; 30: 601-604
        • Nakamura R.
        • Horii E.
        • Imaeda T.
        • Nakao E.
        • Kato H.
        • Watanabe K.
        The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain.
        J Hand Surg Br. 1997; 22: 719-723
        • Hafner R.
        • Poznanski A.K.
        • Donovan J.M.
        Ulnar variance in children–standard measurements for evaluation of ulnar shortening in juvenile rheumatoid arthritis, hereditary multiple exostosis and other bone or joint disorders in childhood.
        Skeletal Radiol. 1989; 18: 513-516
        • Tomaino M.M.
        Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy.
        J Hand Surg Br. 1998; 23: 754-757
        • França Bisneto E.N.
        Dynamic ulnar impaction syndrome in tennis players: report of two cases.
        Rev Bras Ortop. 2017; 52: 621-624
        • Little J.T.
        • Klionsky N.B.
        • Chaturvedi A.
        • Soral A.
        • Chaturvedi A.
        Pediatric distal forearm and wrist injury: an imaging review.
        Radiographics. 2014; 34: 472-490
        • Jawetz S.T.
        • Shah P.H.
        • Potter H.G.
        Imaging of physeal injury: overuse.
        Sports Health. 2015; 7: 142-153
        • Kleinman W.B.
        Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years.
        J Hand Surg Am. 2007; 32: 1086-1106
        • Jupiter J.B.
        Commentary: the effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures.
        J Hand Surg Am. 2009; 34: 1603-1604
        • Smith B.S.
        • Cooney W.P.
        Revision of failed bone grafting for nonunion of the scaphoid. Treatment options and results.
        Clin Orthop Relat Res. 1996; : 98-109
        • Goldfarb C.A.
        • Yin Y.
        • Gilula L.A.
        • Fisher A.J.
        • Boyer M.I.
        Wrist fractures: what the clinician wants to know.
        Radiology. 2001; 219: 11-28
        • Yang Z.
        • Mann F.A.
        • Gilula L.A.
        • Haerr C.
        • Larsen C.F.
        Scaphopisocapitate align- ment: criterion to establish a neutral lateral view of the wrist.
        Radiology. 1997; 205: 865-869
        • Mirghasemi A.R.
        • Lee D.J.
        • Rahimi N.
        • Rashidinia S.
        • Elfar J.C
        Distal radioulnar joint instability.
        Geriatr Orthop Surg Rehabil. 2015; 6: 225-229
        • Wijffels M.
        • Brink P.
        • Schipper I.
        Clinical and non-clinical aspects of distal radioulnar joint instability.
        Open Orthop J. 2012; 6: 204-210
        • Wu M.
        • Miller P.E.
        • Waters P.M.
        • Bae D.S
        Early results of surgical treatment of triangular fibrocartilage complex tears in children and adolescents.
        J Hand Surg Am. 2020; 45 (449.e1-e9)
        • Palmer A.K.
        • Glisson R.R.
        • Werner F.W.
        Ulnar variance determination.
        J Hand Surg Am. 1982; 7: 376-379
        • Cha S.M.
        • Shin H.D.
        • Kim K.C.
        Positive or negative ulnar variance after ulnar shortening for ulnar impaction syndrome: a retrospective study.
        Clin Orthop Surg. 2012; 4: 216-220
        • Cha S.M.
        • Shin H.D.
        • Ahn K.J.
        Prognostic factors affecting union after ulnar shortening osteotomy in ulnar impaction syndrome: a retrospective case-control study.
        J Bone Joint Surg Am. 2017; 99: 638-647
        • Atzei A.
        • Luchetti R.
        Foveal TFCC tear classification and treatment.
        Hand Clin. 2011; 27: 263-272
        • Palmer A.K.
        Triangular fibrocartilage complex lesions: a classification.
        J Hand Surg Am. 1989; 14: 594-606
        • Fernandez D.L.
        • Jupiter J.B.
        Functional and radiographic anatomy.
        in: Ring D. McCarty L.P. Campbell D. Jupiter J.B. Fractures of the distal radius. A practical approach to management. Springer-Verlag, New York1995: 53-66
        • Cha S.M.
        • Choi B.S.
        • Shin H.D.
        Radiological degenerative changes in the distal radioulnar joint after ulnar shortening osteotomy in patients with idiopathic ulnar impaction syndrome: analysis of factors affecting degenerative lesions.
        J Orthop Sci. 2017; 22: 1042-1048
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Fleiss J.L.
        • Cohen J.
        The equivalence of weighted Kappa and the intra- class correlation coefficient as measures of reliability.
        Educ Psychol Meas. 1973; 33: 613-639
        • Iwasaki N.
        • Ishikawa J.
        • Kato H.
        • Minami M.
        • Minami A.
        Factors affecting results of ulnar shortening for ulnar impaction syndrome.
        Clin Orthop Relat Res. 2007; 465: 215-219
        • Baek G.H.
        • Lee H.J.
        • Gong H.S.
        • Rhee S.H.
        • Kim J.
        • Kim K.W.
        • Kong B.Y.
        • Oh W.S.
        Longterm outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up.
        Clin Orthop Surg. 2011; 3: 295-301
        • Nishiwaki M.
        • Nakamura T.
        • Nakao Y.
        • Nagura T.
        • Toyama Y.
        Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study.
        J Hand Surg Am. 2005; 30: 719-726
        • Nishiwaki M.
        • Nakamura T.
        • Nagura T.
        • Toyama Y.
        • Ikegami H.
        Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study.
        J Hand Surg Am. 2008; 33: 198-205
        • Cha S.M.
        • Shin H.D.
        • Jeon J.H.
        Long-term results of Galeazzi-equivalent injuries in adolescents–open reduction and internal fixation of the ulna.
        J Pediatr Orthop B. 2016; 25: 174-182